HOUSE BILL REPORT
E2SHB 1484
As Amended by the Senate
Title: An act relating to the medicaid related payment of property costs in licensed nursing facilities.
Brief Description: Modifying property valuation methods for reimbursing nursing facilities.
Sponsors: By House Committee on Health Care (Originally sponsored by Representatives Parlette, Cody, Alexander, Conway and Edwards).
Brief History:
Committee Activity:
Health Care: 2/4/99, 3/2/99 [DPS];
Appropriations: 3/5/99, 3/6/99 [DP2S(w/o sub HC)].
Floor Activity:
Passed House: 3/12/99, 95-0.
Senate Amended.
Passed Senate: 4/21/99, 45-0.
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Brief Summary of Engrossed Second Substitute Bill
$The current method for determining variable return on investment is retained.
$The current financing allowance for existing facilities and projects (set at 10 percent for all existing facilities) is maintained and the financing allowance for all new assets acquired after the effective date of this act is set at 8.5 percent.
$Facilities that have received certificate of need approval for new construction or major renovation prior to the effective date of this act will receive a financing allowance at 10 percent.
$For new construction or major renovation projects, fixed equipment (wiring, plumbing, heating and air conditioning systems, etc.) will be depreciated using the same life as the building to which it is affixed.
$A bed to population ratio of 40 beds per 1,000 persons 65 or older is placed into statute. The Certificate of Need (CON) process is valid for five years and must be reviewed prior to any continuation.
$Property tax increases resulting from new construction or major renovation projects are paid to the nursing facility in a rate increase up to the operations median.
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HOUSE COMMITTEE ON HEALTH CARE
Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. Signed by 11 members: Representatives Cody, Democratic Co-Chair; Parlette, Republican Co-Chair; Pflug, Republican Vice Chair; Alexander; Boldt; Campbell; Conway; Edmonds; Edwards; Mulliken and Ruderman.
Staff: Antonio Sanchez (786-7383).
HOUSE COMMITTEE ON APPROPRIATIONS
Majority Report: The second substitute bill be substituted therefor and the second substitute bill do pass and do not pass the substitute bill by Committee on Health Care. Signed by 31 members: Representatives Huff, Republican Co-Chair; H. Sommers, Democratic Co-Chair; Alexander, Republican Vice Chair; Doumit, Democratic Vice Chair; D. Schmidt, Republican Vice Chair; Barlean; Benson; Boldt; Carlson; Clements; Cody; Crouse; Gombosky; Grant; Kagi; Keiser; Kenney; Lambert; Linville; Lisk; Mastin; McIntire; McMorris; Mulliken; Parlette; Regala; Rockefeller; Ruderman; Sullivan; Tokuda and Wensman.
Staff: Dave Johnson (786-7154).
Background:
The capital reimbursement rate refers to the cost of capital, buildings, and equipment for each nursing home facility. It is a unique cost-based rate for each nursing facility paid through three components of the overall nursing home rate:
! Property;
! Financing allowance; and
! Variable return.
These three components make up 11 percent of the total average daily Medicaid payment to a nursing home facility. This amounts to $13 of the average daily nursing home rate of $114.74.
Last year the Legislature mandated that the Department of Social and Health Services (DSHS) study and recommend options for the payment of nursing facility capital and property related expenses. The department contracted with an independent consulting company, Myers and Stauffer LC, to conduct the study. The study compared the advantages and disadvantages of the systems used in other states and identified an alternative system that might be used in the state of Washington.
Property: The property cost rate covers the allowable cost of depreciation on assets. Payment for property is calculated as depreciation from the prior year divided by total resident days, or resident days at minimum occupancy, which is 85 percent of the increased beds, whichever is greater.
Financing Allowance: A financing allowance provides for interest expense on debt used to finance capital purchases as well as working capital. It funds nursing home expenses that are of a nature that warrants financing of the purchases over some period of time. Payment for interest and other financing expenses is not based on actual interest expense; instead, a financing allowance is computed. The financing allowance pays for the financing of improvements to facilities, construction of new facilities, and equipment purchases. The financing allowance is calculated as ten percent of fixed assets minus depreciation divided by total resident days or 85 percent occupancy, whichever is greater.
Variable Return: The variable return component of the capital payment rewards facilities that provide services to residents efficiently, and it allows for some profit or to cover other expenses not covered by the reimbursement. This payment is determined by comparing a home's costs to those of other homes. Homes are then divided into four quartiles, according to their level of costs. Each facility is eligible to receive an additional one to four percent of their rate, based on its comparative efficiency. Efficiency is defined as the lowest cost per resident day:
!One percent for facilities in the highest cost quartile;
!Two to three percent for facilities with costs that fall between the highest and lowest cost facilities;
!Four percent for facilities in the lowest cost quartile.
Certificate of Need (CON): The CON process was initiated in Washington State by law in 1971. It was designed to allow the development of new services and facilities in an orderly way that allows for competition to occur within a specific defined planning area, yet does so without destabilizing the existing system. The CON process is administered by the Department of Health (DOH). Currently any nursing facility that wants to initiate a remodel or new construction project exceeding $1.2 million must have the proposed project approved by the certificate on need process prior to any construction. The DOH has established, as part of its needs formula, in rule a statewide ratio of 45 beds to 1,000 persons over the age of 65 as a threshold for considering construction of new nursing facility beds.
Bed Banking: Facilities may take some of their beds off-line through a process known as bed banking. Beds may later be returned to active use or be unbanked.
Summary of Bill:
Property: The depreciation life for fixed equipment is prospectively extended to be the same as the depreciation life used for the building for all new or replacement building construction, or for major renovations receiving CON approval or exemption from approval from the DOH after March 15, 1999. Fixed equipment includes elevators, electrical wiring and fixtures, plumbing, heating and air conditioning systems, and other equipment that is affixed to the building and not subject to transfer.
Financing Allowance: The current financing allowance for existing facilities and projects (set at 10 percent for all existing facilities) is maintained and the financing allowance for all new assets acquired after March 15,1999, is set at 8.5 percent.
Clarification is made to insure that those facilities that have received CON approval for new construction or major renovation prior to March 15, 1999, receive a financing allowance of 10 percent. This clarification also applies to projects not requiring CON approval as long as the working drawings are submitted to the DOH prior to March 15, 1999.
Variable Return: The current method for determining the variable return on investment is retained.
Certificate of Need (CON): A bed to population ratio of 40 beds per 1,000 persons 65 or older is placed into statute. The process provides bed planning criteria in statute consistent with DOH rule. (Current bed to population ratio is 45 per 1,000 defined in rule.) The CON process allows for the redistribution of beds within a planning area that is under the established ratio and restricts the redistribution of beds within a planning area that is over the established ratio. The CON process is valid for five years and must be reviewed prior to any continuation.
Property Tax Adjustment - Nursing facilities that are at or below the lid on the operations component of the rate will receive current funding of property tax increases resulting from new construction or major renovations projects.
EFFECT OF SENATE AMENDMENT(S): Major assets acquired after the effective date of the act are depreciated over at least 40 years. The financing rate is no longer applied to working capital. A "capital portion" of the rate and a "non-capital portion" of the rate are defined. Both rates would then be separately referenced in the operating budget and each subject to the budget dial. Under current law, the total rate is subject to the budget dial. Language is removed which would have set a certificate of need bed-to-population ratio for nursing facility beds in statute. Provisions of the bill related to variable return, property, and financing rate-setting are repealed June 30, 2001.
Appropriation: None.
Fiscal Note: Available.
Effective Date: The bill contains an emergency clause and takes effect immediately.
Testimony For: (Health Care) (Original bill) This measure will be fair to patients who need and deserve a good place to live and to receive good quality of care. It is also fair to existing facilities that have renovated or rebuilt under terms of the current system. Older facilities will benefit.
(Appropriations) (Substitute bill) This is a good bill that honors past commitments made when providers invested in new or remodeled facilities. The capital payment system is important if we want quality facilities. The variable rate of return punishes those who are less efficient. While the bill would be improved by setting a depreciation floor and by the current funding of property taxes, this is an important and good bill.
Testimony Against: (Health Care) (Original bill) This measure will cost additional tax dollars and is not in the Governor's budget.
(Appropriations) (Substitute bill) This bill does not generate the level of savings assumed in the Governor's budget. All providers receive some variable rate of return, even the least efficient ones. This does not appear to be a prudent way to spend money. The money should be provided to home care workers instead.
Testified: (Health Care) (Original bill) (Support) Karen Tynes, Washington Association of Housing Services Assistance; Chuck Hawley, Sisters of Providence; Jerry Reilly, Washington Health Care Association; Robert Ogden, Providence Mount St. Vincent; and Sam Wan, Kin On Health Care.
(Health Care) (Oppose) Denise Gaither, Department of Social & Health Services; and Bruce Reeves, Senior Citizen Lobby.
(Appropriations) (In support) Jerry Reilly, Washington Health Care Association; Karen Tynes, Washington Association of Housing and Services for the Aged; and Linda Hull, Sisters of Providence.
(Appropriations) (Opposed) Nancy Holderman, Department of Social and Health Services.
(Appropriations) (Concerns) Bruce Reeves, Senior Citizens Lobby.